Espinosa Gerard, Herreras José M, Muñoz-Fernández Santiago, García Ruiz de Morales José M, Cordero-Coma Miguel
Servicio de Enfermedades Autoinmunes, Institut Clínic de Medicina i Dermatologia, Hospital Clínic, Barcelona, España.
IOBA (Instituto Universitario de Oftalmobiología), Universidad de Valladolid, Valladolid, España; Servicio de Oftalmología, Hospital Clínico Universitario de Valladolid, Valladolid, España.
Med Clin (Barc). 2020 Sep 11;155(5):220.e1-220.e12. doi: 10.1016/j.medcli.2019.10.023. Epub 2020 Mar 19.
To generate recommendations on the use of immunomodulators in patients with non-infectious, non-neoplastic intermediate uveitis (IU), posterior uveitis (PU) and panuveitis (PanU) based on best evidence and experience.
A multidisciplinary panel of 5 experts was established, who defined the scope, users, and sections of the document. A systematic literature review (SLR) was performed to assess the efficacy and safety of immunomodulatory drugs in patients with non-infectious, non-neoplastic, non-anterior uveitis. The results of the SLR were presented and discussed during an expert meeting in which 34 recommendations were generated. The level of agreement with the recommendations was also tested in 25 additional experts following a Delphi process. Recommendations were voted from 1 (total disagreement) to 10 (total agreement). We defined agreement if at least 70% of the experts voted ≥7. The level of evidence and grade or recommendation were assessed using the Oxford Centre for Evidence-based Medicine Levels of Evidence.
The SLR included 33 articles. The 34 recommendations were accepted after 2 Delphi rounds (3 of them were modified after the first round). They include specific recommendations on patients with non-infectious, non-neoplastic, PU and PanU, as well as different treatment guidelines.
In patients with non-infectious, non-neoplastic, non-anterior uveitis these recommendations might help treatment decision making, due to the lack of robust evidence or other globally accepted algorithms.
基于最佳证据和经验，针对非感染性、非肿瘤性中间葡萄膜炎（IU）、后葡萄膜炎（PU）和全葡萄膜炎（PanU）患者使用免疫调节剂提出建议。
成立了一个由5名专家组成的多学科小组，他们确定了文件的范围、受众和章节。进行了一项系统文献综述（SLR），以评估免疫调节药物在非感染性、非肿瘤性、非前葡萄膜炎患者中的疗效和安全性。在一次专家会议上展示并讨论了SLR的结果，会上提出了34条建议。在德尔菲法之后，还对另外25名专家测试了对这些建议的认同程度。建议的投票范围为1（完全不同意）至10（完全同意）。如果至少70%的专家投票≥7，我们就定义为达成共识。使用牛津循证医学中心的证据等级来评估证据水平和建议等级。
SLR纳入了33篇文章。经过两轮德尔菲法后，34条建议被接受（其中3条在第一轮后进行了修改）。它们包括针对非感染性、非肿瘤性、PU和PanU患者以及不同治疗指南提出了具体建议。
在非感染性、非肿瘤性、非前葡萄膜炎患者中这些建议可能有助于治疗决策，因为缺乏有力的证据或其他全球公认的算法。
